Treating Chronic Pain: Can Doctors Do Better?

When NASCAR racing legend Dick Trickle killed himself last month because of his debilitating chronic pain, it focused considered attention on how pain is diagnosed and treated.

At the National Pain Report, we’ve been talking with pain specialists around the country and found many think that medical schools need to do a better job of preparing physicians to diagnose and treat pain.

bigstock-Doctor-writing-patient-notes-o-16554509“Historically medical schools average only six hours dedicated to pain management, and the bulk of that time is on prescriptions,” said Beth Darnall, PhD, clinical associate professor in Stanford University’s School of Medicine.

Darnall is concerned that patients will rely solely on opiods for chronic pain if they are not given alternative resources, and that those alternative resources aren’t being taught.

UCLA’s Dr. Andrew Charles agrees, calling the diagnosis and treatment of chronic pain “a huge public health problem” because of lost work productivity, the costs to the health care system, and the social costs to pain sufferers and their families.

“Medical schools should do a better of preparing physicians to identify and treat chronic pain,” said  Charles who runs the Headache Research and Treatment Programs at UCLA’s David Geffen School of Medicine.

Charles also says patients need to be better educated about pain as well, calling the lack of training a “global problem.”

The hard truth is that pain is the number one reason for a person in the United States to seek medical attention. And a Denver, Colorado pain physician joins Dr. Charles and Dr. Darnall in the call for medical schools to pay more attention to how we train physicians.

“The academic system in the U.S. has never formed a residency which would produce a physicians who is skilled in the diagnosis and treatment of pain,” said Daniel Bennett, MD, DABPM, a Denver pain physician who is chief medical officer for National Pain Report. “This boils down to money and politics, which is sad.”

Since some current doctors are not up to date on how to diagnose and treat pain, it can be a challenge for chronic pain sufferers to find the right doctor. Arlene Grau of Lakewood, California recently wrote a column for the National Pain Report that likened finding the right doctor to finding a life partner.

“We go through great lengths to confirm that he/she is the one, and, if you’re like me, you have a list of qualities you look for in the person,” Grau said. “If you are a chronic pain sufferer, then finding the right doctor to care for you should be the same way.”

Grau went to several different physicians before she met one that she feels understands and listens to her.

Dr. Darnall points out that some states are doing better. In Washington state, 27 hours of pain education in the medical curriculum is required, but she emphasized “this is by no means a national practice.”

Experts we’ve talked to think that more physicians need to be able to communicate better with their patients.

This means a better understanding of the physiological mechanisms of pain, the psychological factors that influence pain, the benefits of multidisciplinary pain care, and an emphasis on patient empowerment — connecting patients with resources and information to best manage their pain.

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5 Responses

  1. trudy myers says:

    My chronic pain is barely managed at all and now my Mds have cut the dose and I am out of my mind in pain-I live in a rural area and have no choices really-its awful

  2. Trey Barber says:

    Hello. Please answer these questions:
    1. Why do Doctor’s say the pain is in your head just because they cannot diagnose the origin of pain?
    2. People suffering from hellish pain need opioids just like diabetics need insulin. Why does the medical community treat diabetics like patients and chronic pain patients like criminals or drug addicts?
    3. Why are medical people concerned with addiction for patients with non-curable painful medical conditions and will have to take opioids the rest of their lives?
    Take care.

  3. Jannie White says:

    I was diagnose with rsd/crps 7 years ago and I went in and out of he_ _ after a surgery just to find out what I have plus being told it was a mental problem and I would be in a wheel chair for the rest of my life not to mention the pain medication they so happily gave me did not work. Its so true the medical field needs to be educated. I found information from 2000 years ago that help me today and its simple the main thing is a lot of will power weather patters and what not to eat and drink for these too will up pain. Now into my 8 year of this monster Im so glad I did not listen to the 13 doctors for I would have been really messed up

  4. Linda Tyson says:

    What do you do when you’ve found the right team and worker’s comp refuses to provide the treatment because much of it is alternative medicine; not scientific? I have suffered the past 3.5 years after 2 failed back surgeries due to poor post operative care due to denials by the work comp carrier as “not needed or necessary”. As a result and ongoing denial after denial of treatment that my medical team ans I have determined worked for me. I’m worse than I was from the original injury almost 20 years ago, being placed me in the category as a chronic pain patient. I have used my own medical insurance, cash, the state hospital to receive the alternative care wich helps me live. Worker’s Comp calls alternative medicine “passive and not scientific” but along with an exercise program tailored for me, it allows me to live; not totally take the pain away but be productive. Their scientific remedies have placed me in this category of a chronic pain patient. The Worker’s Comp system (especially California), has injured claimaints psychologically because of their poor treatment or non treatment. This system needs to be investigated as malpractice, especially the Utilization Review Dept. who sit behind a desk, not even practicing medicine, hand down the ongoing decisions of denials when top scholars in their fields, prescribe treatment based upon research of patients that has proven successful. Chronic pain patients must not be placed in a box. We must be listened to and understood. If the doctors we visit don’t have that spirit or patience, they are not the practitioner for us.

  5. Dennis Kinch says:

    The whole medical system can do better. When I was a patient at Mass General in Boston, they literally saved my life, and all they had to say to cause this was, “We don’t know what’s causing your pain, but we believe you’re in chronic severe pain and have been for awhile. We will treat the pain while we look for a diagnosis.” They had the first Pain Center I’d ever seen, with all available medical treatments for pain available on referral. They handled all my meds and tests and it was my pain doc who finally diagnosed the bone marrow disease.All that was missing was involvement with alternative med practices. It was far too late to save my marriage, my kids, my job, my home, my insurance and all of my money, and I had reached the point of no return; and all it took was the doctors and their system believing me, trying to help me, and jumping on it like I had cancer or something. Why can’t pain docs treat patients like other diseases get treated? Remember, I had very good insurance before they all turned on me and I had no insurance or job or money, I was actually homeless in Boston when I qualified for their “Obamacare” system. It saved me. My disease is permanent and deteriorating fast, but all the years of being with my daughters and being as productive and happy as possible, I owe to MassGeneral and a system based on “the customer’s always right.”

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